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Helping children transition to healthcare independence

P. Davis Smith, M.D. [October 06 2011]

Your adolescent child who has recently left for college texts that she is sick. How might you respond?
When an older adolescent leaves home for the first time – whether for college or a job – it's a time of transition in many ways and also an opportunity for the adolescent to become more empowered in assuming personal responsibility for their health status and health care. There are steps you and your child can take to help with this transition.

Prepare together
Talk to your child about available healthcare resources near where she'll be. If she gets sick while away, will she be consulting a local clinician, such as at the college health service, or a home-based primary care provider? Help her understand insurance coverage. Will the Emergency Department nearest to her be in the insurance provider's network? Encourage her to think through and prepare a medical kit of her own. What prescription and over the counter medicines does she routinely use? Does she have a pair of glasses with appropriate prescription in case she loses or has a problem with her contact lenses? How about a thermometer?

Support the decision-making process
If she contacts you about a minor health issue, support her working it out on her own. At the same time, you might talk to her about your own decision-making process as to when to push through illness and when to rest. Look for opportunities to help her make her own decisions. You might say that sometimes the responsible thing to do is not go to class or work because doing so may spread illness to others and is likely to prolong her recuperation. She should be making the call to discuss her concern with a healthcare provider as well as notifying deans or supervisors of the illness if it is likely to impair her ability to complete work. Remind her that recovering from illness usually takes time. If the illness/condition is not resolving or responding as anticipated, encourage her to follow up with her healthcare provider. As your child matures, she should be encouraged to take on increasing responsibility for healthcare issues. Most adolescents should be essentially autonomous for healthcare decision making by the age of 21.

When to intervene
Some adolescents, such as those with uncontrolled eating disorders, substance use or mood disturbances, absolutely need the intervention of their families. They have proven themselves to be, at least temporarily, a risk to themselves. Even these individuals, though, will not be able to maintain full recovery until they are fully responsible for their own decision making.
Most of us expect that our children will eventually become fully autonomous regarding healthcare decision-making. We expect this to be a process, like other adolescent transitions to independence. We further expect it to be variable: They are less likely to involve us in decision making for minor issues or for intimate issues such as sexual health concerns, but more likely to involve us for more complicated issues that are more intrusive in their daily lives. Approaching this transition in a mindful way is likely to ease the process for all involved.

Dr. P. Davis Smith is a member of The Hospital of Central Connecticut (HOCC) medical staff. For referrals to HOCC physicians, please contact our free Need-A-Physician referral service by phone at 1-800-321-6244 or online. Dr. P. Davis Smith is with Doctors of Central Connecticut